Our Treatment Approach
Social Communication Anxiety Treatment® (S-CAT®) is the evidenced-based philosophy of treatment developed by Dr. Elisa Shipon-Blum and implemented only at the SMart Center. Dr. Shipon-Blum’s S-CAT® treatment method has been studied by the Selective Mutism Research Institute (SMRI).
The S-CAT® program is effective for children, teens, and adults with Selective Mutism (SM), social anxiety, extreme shyness, and related social communication issues.
S-CAT® is based on the concept that SM is a social communication anxiety disorder that is more than just not speaking. S-CAT® integrates components of behavioral-therapy, Cognitive-behavioral therapy (CBT), and an insight-oriented approach to increase social communication and promote social confidence. Tactics such as systemic desensitization, modeling, fading, positive reinforcement, etc. enable the child to development social engagement skills and to progress communicatively in a step-by-step manner at home, in school, and in real world settings. Treatment is individualized and based on the individual’s unique needs.
Dr. Shipon-Blum created the Stages of Social Communication Comfort Scale to describe the various stages of social communication that are possible for a child suffering from Selective Mutism. The Social Communication Bridge© (pictured right) illustrates this concept in a visual form.
Research conducted by the Selective Mutism Research Institute (SMRI), with Dr. Evelyn Klein as the principal investigator, provides substantial evidence for the efficacy of S-CAT®. View the published study synopsis here.
A key principle of this treatment is understanding that children suffering from Selective Mutism change their level of social communication based on the setting and the expectations from others within a setting. A child with Selective Mutism will have difficulty socially engaging and communicating nonverbally (or may not be able to communicate at all) when feeling anxious or uncomfortable. For some children, mutism is the most noted symptom of this anxiety. This usually means that they are able to engage nonverbally with others via their astute nonverbal skills (like professional mimes). These children are stuck in the nonverbal stage of communication and suffer from a subtype of SM called: Speech Phobia©.
This subtype of SM demonstrates that although mutism is the most noted symptom in most of our children, it merely touches on the surface of what’s going on. A complete understanding of the child is necessary to develop an appropriate treatment plan, school based accommodations, and/or interventions.
According to Dr. Shipon-Blum’s work, after a complete evaluation (consisting of various parent and teacher assessment forms, parent and child interviews), treatment needs to address three key questions:
- Why did the child develop Selective Mutism? (influencing, precipitating, and maintaining factors)
- Why does Selective Mutism persist despite past treatment and parent/teacher awareness?
- What can be done at home, in school, and in real world settings to help the child build the coping skills necessary to overcome his or her social communication challenges?
Treatment is developed via a holistic or “whole-individual” approach. The parents, child, and school personnel work together under the direction of the outside treatment professional. Dr. Shipon-Blum emphasizes that although lowering a child’s anxiety is key, it is often not enough, especially as children get older. Over time, many children with Selective Mutism no longer feel anxious, but their mutism and lack of proper social engagement continues in select settings due to learned behaviors.
Children with SM need strategies and/or interventions to progress from nonverbal communication to spoken communication. This is the Transitional Stage of Communication© (Stage 2 on the Social Communication Bridge©), and this aspect is missing from most treatment plans.
How do you help a child progress from nonverbal to verbal communication? Time in the therapy office is simply not enough. The office setting is used to help prepare the child for the school and real work environments by developing strategies that help the child unlearn his/her conditioned behavior. Then, within the school and real world settings, the strategies/interventions are implemented.
Strategies and interventions are developed based on where the child is on the Social Communication Bridge© in a particular setting, and are meant to be desensitizing as well as a vehicle to unlearn conditioned behavior. S-CAT® incorporates anxiety lowering techniques, methods to build self-esteem, and strategies/interventions to help with social comfort and communication progression. This may include “Bridging” from shut down to nonverbal communication and then transitioning into spoken communication via verbal intermediaries, ritual sound shaping, and possibly the use of augmentative devices.
A key concept is that children with SM need to understand, feel in control of, and have choice in their treatment (age dependent). This is a critical component of S-CAT.
S-CAT provides choices to the child and helps to transfer the child’s need for control into the strategies and interventions. Games and goals (based on age) are used to help develop social comfort and ultimately progress into speech via the use of ritualistic and controlled methods (e.g., strategy charts). Silent goals (environmental changes) and active goals (child directed goals based on choice and control) are used within the S-CAT program as well.
Every child is different and therefore an individualized treatment plan needs to be developed that incorporates home (parent education, environmental changes), the child’s unique needs, and school modifications (teacher education, accommodations/interventions).
By lowering anxiety, increasing self-esteem, and increasing communication and social confidence within a variety of real world settings, the child suffering in silence will develop the needed coping skills to enable for proper social, emotional and academic functioning.